Use of dietetic-specific nutritional diagnostic codes in clinical reasoning relevant to the nutritional management of core clinical outcome indicators in hemodialysis patients

The effect of blood draw methodology on selected nutritional parameters in chronic renal failure

The reliability and validity of any clinical laboratory test is directly affected by the integrity of the blood specimen obtained for analysis. Renal failure patients undergo a high number of laboratory tests, primarily to monitor the quality of care. Subsequent tests to confirm laboratory abnormalities are costly and place the patient at unnecessary risk for additional blood loss. Three of the four Health Care Financing Administration core clinical outcome indicators have nutritional implications and use laboratory values as part of review criteria: adequacy of dialysis, albumin, and anemia. National Kidney Foundation-Dialysis Outcomes Quality Initiative (DOQI) Clinical Practice Guidelines have recommended standardized predialysis and postdialysis blood draw procedures to increase accuracy for adequacy of dialysis. The National Committee on Clinical Laboratory Standards publishes peer-reviewed guidelines for venipuncture. Together, the adoption of these standards would minimize preanalytical variation and improve the data used to monitor the quality of care in renal patients.